Factors predicting survival following alloSCT in patients with therapy-related AML and MDS: a multicenter study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 58; no. 7; pp. 769 - 776
• Main Authors: Baranwal, Anmol, Chhetri, Rakchha, Yeung, David, Clark, Matthew, Shah, Syed, Litzow, Mark R., Hogan, William J., Mangaonkar, Abhishek, Alkhateeb, Hassan B., Singhal, Deepak, Cibich, Alia, Bardy, Peter, Kok, Chung H., Hiwase, Devendra K., Shah, Mithun Vinod
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.07.2023; Nature Publishing Group
• Subjects: 692/308; 692/499; Allografts; Cell Biology; Cell survival; Diagnosis; Health risks; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Internal Medicine; Karyotypes; Leukemia, Myeloid, Acute - genetics; Leukemia, Myeloid, Acute - therapy; Medicine; Medicine & Public Health; Monosomy; Neoplasm Recurrence, Local; Neoplasms; p53 Protein; Public Health; Retrospective Studies; Risk; Stem cell transplantation; Stem Cells; Survival; Transplantation, Homologous; Tumors
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-023-01970-0

Therapy-related myeloid neoplasms (t-MN) are aggressive myeloid neoplasms. Factors predicting post-allogeneic stem cell transplant (alloSCT) survival are not well-known. We studied the prognostic utility of factors at: t-MN diagnosis, pre-alloSCT, and post-alloSCT. Primary endpoints were 3-year overall survival (OS), relapse incidence (RI), and non-relapse mortality (NRM). Post-alloSCT OS did not differ between t-MDS and t-AML (20.1 vs. 19.6 months, P  = 1), though t-MDS had a significantly higher 3-year RI compared to t-AML (45.1% vs. 26.9%, P  = 0.03). In t-MDS, the presence of monosomy 5 (HR 3.63, P  = 0.006) or monosomy 17 (HR 11.81, P  = 0.01) pre-alloSCT were associated with higher RI. Complex karyotype was the only factor adversely influencing survival at all the timepoints. The inclusion of genetic information yielded 2 risk-categories: high-risk defined by the presence of pathogenic variants (PV) in ( TP53 / BCOR / IDH1 / GATA2 / BCORL1) and standard-risk (remainder of the patients) with 3-year post-alloSCT OS of 0% and 64.6%, respectively ( P  = 0.001). We concluded that while alloSCT was curative in a subset of t-MN patients, outcomes remained poor, specifically in the high-risk category. t-MDS patients, especially those with persistent disease pre-alloSCT were at increased risk of relapse. Disease-related factors at t-MN diagnosis were the most prognostic of post-alloSCT survival; utility of factors available later in the course, was incremental.